Breaking down the fear barrier: How the consumer learning effect can increase vaccination uptake

Vaccination programs have the potential to substantially reduce the health and economic burden of many common diseases. However, vaccine uptake is far from optimal. One suggested reason for this is a general fear and mistrust of vaccinations. In their paper ‘Learning to Trust Flu Shots’ Jürgen Maurer and Katherine Harris investigate how the consumer learning process can help build trust and improve influenza vaccination use.

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Jürgen Maurer is a professor of health economics and managemen. Among other topics, he is interested in public health, aging and demography.

Ill-health does not just have a personal cost for the individuals who become unwell; it also has a broader economic impact, through loss of productivity and public health costs, for example. Research published in 2007 revealed that annual flu outbreaks in the US can lead to a staggering 600,000 life-years lost, 3 million hospital days, 31 million outpatient visits and 44 million days of productivity lost, creating an average immediate health and economic burden of many billions of dollars a year (some estimates put the figure as high as US $87.1 billion annually).

Fortunately, however, it is possible to reduce the incidence of many common infectious illnesses, including influenza, one of the most prevalent and costly illnesses in economic terms, through effective vaccination programs. Yet, despite considerable medical advances in the field of vaccination, the uptake of vaccinations is far from optimal, often failing to meet national targets. For example, the US Centers for Disease Control and Prevention (CDC) put the number of US adults receiving the flu vaccine during the 2015–16 flu season at just 42 per cent, against a target of 70 per cent.

Fear of the unknown

While there are many possible reasons for relatively low vaccine uptake, one frequently cited reason is a general mistrust of vaccinations. Many people possess unfavorable attitudes towards and beliefs about influenza vaccinations. If consumers do not trust vaccines, they are less likely to use them. However, as Jürgen Maurer, Professor of health economics and management at HEC Lausanne, and Katherine Harris, a principal research scientist, at research consultants IMPAQ, reveal in their research on vaccination programs, like other products trust in vaccines can be built through consumer experience and a process known as consumer learning.

In consumer learning, as Maurer and Harris note in their paper ‘Learning to Trust Flu Shots’, the consumer’s experience of a product or service results in “new insights, attitudes and beliefs regarding uncertain product characteristics, which in turn provide the basis for future product demand”.

When Harris, Maurer and team were gathering influenza vaccination-related data in the US for private corporations and public bodies, one issue always seemed to emerge in discussions with practitioners – there was a sense that a diffuse fear of influenza vaccination, a general uneasiness, among potential users was a barrier to uptake. But if people could be encouraged to use the vaccine once, they were much more likely to become repeat users. This view was supported by data that showed relatively large groups of people who never used vaccines or who were regular users, but relatively few sporadic users.

A significant challenge was finding a way to test for the possible casual effects of consumer learning on vaccine uptake. However, the outbreak of the swine flu (H1N1) pandemic and the use of a swine flu vaccine alongside the regular flu vaccine in the US in 2009, presented a rare opportunity for the authors. While the seasonal vaccine targeted the 50 plus age group, as well as certain individuals with high-risk health conditions, the swine flu vaccine was initially targeted at young adults aged 18–24 years, but also made available to the general population. This allowed Maurer and Harris to gauge how past experiences of the seasonal flu vaccine in the two groups might causally affect their attitudes towards the pandemic vaccine and pandemic vaccine use.

Using self-reported survey data of US households Maurer and Harris investigated uptake of and attitudes towards the swine flu vaccine – notably whether people perceived the vaccine as worth taking and how safe they considered it. The data showed that people who had previous regular experience of the seasonal flu vaccine were more likely, everything else being equal, to take the pandemic vaccination, even though they were not necessarily in the specifically recommended target group. They were also more likely to consider it of value and safe.

There were some caveats. The research uncovered the spillover effect of how experience of one type of vaccine (seasonal flu) influenced attitudes towards another type of vaccine (swine flu) in the future – rather than the same type of vaccine. And, given the heightened media coverage of swine flu at the time, it might be possible that fear of catching swine flu outweighed any diffuse fear of vaccinations. Nevertheless, even if not entirely definitive, Maurer believes that the clear evidence of spillover effects from seasonal vaccination experiences to pandemic vaccine uptake, suggests that past experience of a seasonal vaccine could make an individual more likely to take a seasonal vaccine in the future.

Factoring in the consumer learning effect

A number of important insights for practitioners emerge from the research. For those tasked with increasing the uptake of vaccinations it is important to factor in the probable future impact of any campaign, through consumer learning effects, when considering the cost effectiveness of that campaign. These dynamic effects mean that the benefits of a public health campaign designed to encourage participation in a vaccination program are likely to last beyond any particular influenza season and have a positive impact on vaccine uptake in future years.

The significance of the initial experience is also apparent. Public health officials need to maximize the number of people willing to have that initial vaccination experience in order for the consumer learning effect to influence future behavior. Interestingly, other research by Maurer suggests that people are more likely to get vaccinated for the first time if that vaccination takes place in a medical setting, as part of a routine visit to a physician, for example. Thereafter, following that first vaccination the consumer learning effect may make people more amenable to future use of vaccines in non-medical settings, such as a pharmacy, drugstore or workplace, which has both cost and convenience implications.

The concept of consumer learning and its effects are well-understood in the consumer product marketing world, but less so in the sphere of public health. This research by Maurer and Harris is an important contribution to a small but growing body of work which demonstrates the benefit of the consumer learning effect in public health situations. Its findings have the potential to improve vaccination uptake (and not just for influenza) and reduce the huge annual cost burden of infectious diseases for governments and individuals.